Mrs A complained about the management and care her late brother, Mr B, received at Wrexham Maelor Hospital and specifically, whether the decision to operate in March 2023, rather than administer neoadjuvant reduction therapy (cancer treatment, such as chemotherapy, which is carried out before the main treatment) first, was clinically appropriate. She also raised concerns about whether her brother received appropriate follow-up investigations following his surgery in March 2023.
The Ombudsman’s investigation found that the decision to operate on Mr B, which was a decision made mutually with him in March 2023 and was in line with the recommendation of the lower gastrointestinal multi-disciplinary team (the MDT), was clinically appropriate.
The investigation found that broadly, Mr B received appropriate post-surgical investigations and follow up after his April 2023 surgery. However, the investigation identified that the results of Mr B’s raised Carcinoembryonic Antigen test result (a CEA test is used to help predict whether a cancer has reoccurred), should have been referred for further MDT consideration as to whether additional investigations were necessary. This is because it had risen significantly in December 2023 compared to the August. Instead, reliance was placed on an inflammatory explanation for Mr B’s increased CEA following surgery to reverse an ileostomy. The Ombudsman concluded that MDT consideration of Mr B’s raised CEA might have prompted earlier investigations and therefore identification that Mr B’s colorectal cancer had spread. Whilst it would have been very unlikely to have changed Mr B’s sad outcome, it might have led to an earlier palliative referral and more effective pain management for Mr B, sooner than in fact occurred. It might also have provided Mr B with more time for end-of-life planning. The Ombudsman found that the resulting uncertainty around this aspect of Mr B’s management represented an injustice to Mr B, his family and Mrs A. It was to this extent only that this part of Mrs A’s complaint was upheld.
The Ombudsman recommended that the Health Board apologise to Mrs A for the service failing identified in the report, and that it shares the report with relevant clinicians in the Colorectal Team as well as the MDT to facilitate learning.